A .LAGZIRI . OAIT  KEAJJAT  A.EZZAOUAK A.MASMOUDI ;N.BERRADA 

Authors’ affiliation: Cardiology Department of Military Hospital.

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Abstract

Introduction: Posterior Ventricular Septal Rupture is a rare but often fatal complication of a recent acute myocardial infarction, it remains a considerable mortality rate, with a very dark forecast. The total incidence is difficult to evaluate because the clinical and anatomopathological series are very different. Indeed, most patients die immediately before getting admitted into the hospital, thus without any confirmation of the cause of death.

Objectives: It is very important to know their clinical demonstrations in order to specify the diagnosis by echocardiography and to allow an urgent medico-surgical assumption of responsibility. We will illustrate this fatal complication of the myocardial infarction    through a clinical case.

Methods and results:  A 67 year old  patient, smoker, diabetic under insulin, presented infarctus-like thoracic pain with a persistent dyspnea of effort. The examination finds a patient conscious, eupneic BP 100/60 mmhg, cardiovascular auscultation finds regular noises of heart with a holosystolic breath that is a maximal at the left sternum endopex ECG shows RRs 43 bpm ST elevation an inferior with an image out of mirror into former ETT shows  a septal rupture The interventricular septum is dilacerated in its average lower part, the rupture extending from the base of the posterior mitral pillar to the free wall of the ventricle right, where it seems contained by the pericardium. It results a left-right shunt. The right ventricle is dilated and presents a severe dysfonction, whereas the contractile deterioration of the left ventricle is limited the evolution was fatal and the patient went into shock and died few hours after his admission. 

Discussion: The myocardic rupture occurs typically 1 to 4 days after the infarction, and occurs in general with level of the zone of junction between the healthy myocardium and the myocardium infarci.
The diagnosis depends initially on the context: it is about a recent infarction, generally revascularized with delay. The clinical examination can to reveal a systolic breath associated or not with
hoop nets hemodynamic. The final diagnosis is posed by cardiac echography.

The gold-standard treatment is a surgical intervention, regardless, in order to help prevent death prior to surgery, and give the chances of the surgery to be successful, physicians must give oxygen, vasodilators, administer diuretics and inotropic agents. There is no consensus about the risks or benefits of using positive inotropic agents. But, positive inotropic agents should only be used in patients that are hypotensive (systolic BP < 90 or 80 mmHg) or are in cardiogenic shock. Myocardic ruptur remains of a dark forecast; total mortality according to this complication is estimated to 90%
under medical care, and to 50% without surgery

Conclusion: A good clinical knowledge of this complication often helps to identify them precociously and to take the diagnostic and therapeutic measures suitable as soon as possible. The echocardiography makes it possible to specify the diagnostic, its importance and to direct the therapeutic strategy which is generally surgical.

Keywords: septal rupture .infarctus of myocarde prognosis.